IV. Assess the safety of these agents by examining the toxicity profile. V. Correlate the
response of mesenchymal-epithelial transition factor (MET) molecular status.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive cabozantinib-s-malate orally (PO) once daily (QD) on days 1-28.
Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive temozolomide PO daily on days 1-5. Courses repeat every 28 days in
the absence of disease progression or unacceptable toxicity. If temozolomide is not
available, patients receive dacarbazine intravenously (IV) over 15-60 minutes on day 1.
Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
At the time of progression patients may cross-over to Arm I.

After completion of study treatment, patients are followed up every 12 weeks for 2 years.

Inclusion Criteria:

- Histologically or cytologically confirmed uveal melanoma that is metastatic or
unresectable; if histologic or cytologic confirmation of the primary is not
available, confirmation of the primary diagnosis of uveal melanoma by the treating
investigator can be clinically obtained, as per standard practice for uveal melanoma;
pathologic confirmation of diagnosis will be performed at the participating site

- Measurable disease defined as at least one lesion that can be accurately measured in
at least one dimension (longest diameter to be recorded for non-nodal lesions and
short axis for nodal lesions) as >= 20 mm with conventional techniques or as >= 10 mm
with spiral computed tomography (CT) scan or magnetic resonance imaging (MRI)

- Prior therapies allowed, except for those treatments directed toward, or with
activity against, c-Met or vascular endothelial growth factor/receptor (VEGF/R), and
the chemotherapy agents temozolomide and dacarbazine; prior treatment must have been
no earlier than 3 weeks prior to starting treatment with cabozantinib with exceptions
noted and the following: at least 4 weeks since prior hepatic infusion or at least 2
weeks since radiation therapy

- No cytotoxic chemotherapy including investigational cytotoxic chemotherapy or
biologic agents (e.g., cytokines or antibodies) within the last 3 weeks, or
nitrosoureas/mitomycin C within 6 weeks before the first dose of study treatment; at
least 6 weeks must have elapsed if the last regimen included an anti-cytotoxic
T-lymphocyte antigen 4 (CTLA4) antibody; patients must have experienced disease
progression on their prior therapy in the opinion of the treating investigator

- No prior radiation therapy within the last 4 weeks, except as below

- To the thoracic cavity, abdomen, or pelvis within 12 weeks before the first dose
of study treatment, or has ongoing complications, or is without complete
recovery to < grade 1 toxicity

- To bone or brain metastasis within 14 days before the first dose of study
treatment

- To any other site(s) within 28 days before the first dose of study treatment

- Prior radiation treatment may have included no more than 3000 centigray (cGy) to
fields including substantial bone marrow

- No prior radionuclide treatment within 6 weeks of the first dose of study treatment

- No prior treatment with a small molecule kinase inhibitor or a hormonal therapy
within 14 days or 5 half-lives (whichever is longer)

- No concomitant anti-cancer therapy within 28 days of the first dose of study
treatment, including other investigational agents; palliative radiation therapy will
not be allowed while on protocol

- A corrected QT interval calculated by the Fridericia formula (QTcF) =< 500 ms within
28 days before randomization; note: if initial QTcF is found to be > 500 ms, two
additional electrocardiograms (EKGs) separated by at least 3 minutes should be
performed; if the average of these three consecutive results for QTcF is =< 500 ms,
the patient meets eligibility in this regard

- Common Terminology Criteria for Adverse Events (CTCAE) recovered to baseline or CTCAE
=< grade 1 from toxicity due to all prior therapies except alopecia and other
non-clinically significant adverse events (AEs)

- No active brain metastases or epidural disease; patients with brain metastases
previously treated with whole brain radiation or radiosurgery or patients with
epidural disease previously treated with radiation or surgery who are asymptomatic
and do not require steroid treatment for at least 2 weeks before starting study
treatment are eligible; neurosurgical resection of brain metastases or brain biopsy
is permitted if completed at least 12 weeks before starting study treatment; baseline
brain imaging with contrast-enhanced CT or MRI scans for patients with known brain
metastases is required to confirm eligibility

- No clinically significant gastrointestinal bleeding within 24 weeks before the first
dose of study treatment

- No hemoptysis of >= 0.5 teaspoon (2.5 mL) of red blood within 12 weeks before the
first dose of study treatment

- No signs indicative of pulmonary hemorrhage within 12 weeks before the first dose of
study treatment

- No prior radiographic evidence of cavitating pulmonary lesion(s)

- No tumor in contact with, invading or encasing any major blood vessels

- No evidence of tumor invading the gastrointestinal (GI) tract (esophagus, stomach,
small or large bowel, rectum or anus), or any evidence of endotracheal or
endobronchial tumor within 28 days before the first dose of treatment

- The patient may not have uncontrolled, significant intercurrent or recent illness
including, but not limited to, the following conditions:

- Cardiovascular disorders including:

- Congestive heart failure (CHF): New York Heart Association (NYHA) class III
(moderate) or class IV (severe) at the time of screening

- Any of the following within 24 weeks before the first dose of study
treatment:

- Abdominal fistula

- Gastrointestinal perforation

- Intra-abdominal abscess; Note: complete resolution of an
intra-abdominal abscess must be confirmed prior to initiating
treatment with cabozantinib even if the abscess occurred more that 24
weeks before the first dose of study treatment

- Bowel obstruction or gastric outlet obstruction

- Other clinically significant disorders such as:

- Serious non-healing wound/ulcer/bone fracture within 28 days before the
first dose of study treatment

- History of organ transplant

- Concurrent uncompensated hypothyroidism or thyroid dysfunction within 7
days before the first dose of study treatment

- History of major surgery as follows:

- Major surgery in past 6 weeks of the first dose of cabozantinib if
there were no wound healing complications or within 24 weeks of the
first dose of cabozantinib if there were wound complications

- Minor surgery within 4 weeks of the first dose of cabozantinib if
there were no wound healing complications or within 12 weeks of the
first dose of cabozantinib if there were wound complications

- In addition, complete wound healing from prior surgery must be
confirmed at least 28 days before the first dose of cabozantinib
irrespective of the time from surgery

- Active infection requiring systemic treatment within 28 days before the
first dose of study treatment as per the protocol template

- No concomitant treatment, in therapeutic doses, with anticoagulants such as warfarin
or warfarin-related agents, heparin, thrombin or factor Xa inhibitors, or
antiplatelet agents (e.g., clopidogrel); low dose aspirin (=< 81 mg/day), low-dose
warfarin (=< 1 mg/day), and prophylactic low molecular weight heparin (LMWH) are
permitted; please note that drugs that strongly induce or inhibit cytochrome P450 3A4
(CYP3A4) or are associated with a risk of Torsades are not allowed; chronic
concomitant treatment of CYP3A4 inducers is not allowed (e.g., dexamethasone,
phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital, and St.
John's Wort); as part of the enrollment/informed consent procedures, the patient will
be counseled on the risk of interactions with other agents, and what to do if new
medications need to be prescribed or if the patient is considering a new
over-the-counter medicine or herbal product; the following drugs are strong
inhibitors of CYP3A4 and are not allowed during the treatment with cabozantinib:

- Boceprevir

- Indinavir

- Nelfinavir

- Lopinavir/ritonavir

- Saquinavir

- Telaprevir

- Ritonavir

- Clarithromycin

- Conivaptan

- Itraconazole

- Ketoconazole

- Mibefradil

- Nefazodone

- Posaconazole

- Voriconazole

- Telithromycin

- Drugs with possible or conditional risk of torsades should be used with caution
knowing that cabozantinib could prolong the QT interval

- Patients who are pregnant or nursing are not eligible; women of child bearing
potential must have a negative serum or urine pregnancy test within 16 days prior to
registration; this is because the effects of cabozantinib on a developing fetus at
the recommended therapeutic doses are unknown; women of child-bearing potential
include:

- Any female who has experienced menarche and who has not undergone surgical
sterilization (hysterectomy, bilateral tubal ligation or bilateral oophorectomy)
or is not postmenopausal (defined as amenorrhea >= 12 consecutive months)

- Women who are using oral, implanted or injectable contraceptive hormones or
mechanical products such as an intrauterine device or barrier methods
(diaphragm, condoms, spermicides) to prevent pregnancy or practicing abstinence
or where partner is sterile (e.g., vasectomy)

- No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to cabozantinib, temozolomide and dacarbazine

Type of Study:

Study Design:

Outcome Measure:

PFS4

Outcome Description:

A patient will be declared a PFS4 success if they are on study and progression free for at least 4 months. This study will be declared promising if a one-sided chi-squared test for a difference in PFS4 rates yields a p-value of less than 0.10.

Outcome Time Frame:

At 4 months

Safety Issue:

No

Principal Investigator

Jason Luke

Investigator Role:

Principal Investigator

Investigator Affiliation:

Cancer and Leukemia Group B

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2013-00821

NCT ID:

NCT01835145

Start Date:

April 2013

Completion Date:

Related Keywords:

Ciliary Body and Choroid Melanoma, Medium/Large Size

Ciliary Body and Choroid Melanoma, Small Size

Iris Melanoma

Metastatic Intraocular Melanoma

Recurrent Intraocular Melanoma

Stage IIIA Intraocular Melanoma

Stage IIIB Intraocular Melanoma

Stage IIIC Intraocular Melanoma

Stage IV Intraocular Melanoma

Melanoma

Uveal Neoplasms

Name

Location

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